5 Tips to Get a Long-Term-Care Insurer to Pay Up

A long-term-care insurance policy can help cover the costs of care in a nursing home, an assisted-living facility or at home. Follow these steps, and you’re more likely to get through the claims process smoothly.

1. Find out what triggers benefits. Most policies pay only if the patient needs help with at least two out of six activities of daily living (such as bathing or dressing) or there is evidence of cognitive impairment. But the requirements for making a claim vary. Work with your parent’s doctor to provide the information the insurer needs.

2. Find out about home-care requirements. If you plan to provide care at home for your parent, call the insurer to find out about requirements for payouts -- especially before you hire a caregiver to come into the home. Some insurers require home caregivers to be licensed or from an agency, for example. A few pay benefits even to relatives who provide care. Many insurers have care coordinators who can help you search for caregivers or facilities.

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3. Understand the waiting period. Most policies have waiting periods of at least 60 days. However, some companies have a zero-day waiting period for home care but a longer waiting period for assisted living or nursing homes. Others count every calendar day from the time your parent met the requirement for needing help with activities of daily living or the cognitive-impairment requirement, even if he or she didn’t receive care every day. Still others count only the days on which your parent received care -- which can extend the waiting period. To speed things up, you may want to have a caregiver come in for a shorter period for more days rather than a longer period for fewer days.

4. Keep track of the paperwork. That includes forms you submit and communications with the facility and the long-term-care insurer. Sometimes payouts are delayed because of paperwork issues. Keep records of all phone calls and dates that you or the doctor or the facility sent information, and follow up to make sure the paperwork has been received. Also ask your insurer or agent if there is anything you can do to streamline the paperwork; some insurers will arrange direct billing between the nursing home and insurer.

5. Appeal a denied claim. If you have a dispute, work through the insurer’s appeals process, and contact your state insurance department for help.